Relationship Between Steroid Hormone Profile and Premenstrual Syndrome in Women Consulting for Infertility or Recurrent Miscarriage

Joseph V Turner; Lucas A McLindon; Damien V Turner; Yolaine Alefsen; René Ecochard

doi:10.1007/s43032-023-01375-w

Reproductive Endocrinology · Luteal Phase

Relationship Between Steroid Hormone Profile and Premenstrual Syndrome in Women Consulting for Infertility or Recurrent Miscarriage

Turner JV, McLindon LA, Turner DV, Alefsen Y, Ecochard R

Published March 2024 Reproductive sciences (Thousand Oaks, Calif.)

DOI 10.1007/s43032-023-01375-w PMID 37853154 PMC PMC10912418

RRM Academy Synopsis

Infertility clinic women with PMS had lower late-luteal progesterone

In a cross-sectional study of 894 women at a fertility clinic, women with PMS symptoms had lower average progesterone late in the luteal phase. Blood tests could not reliably tell which of these women had PMS.

Key Findings

From 2011 to 2021, 2666 women had the clinic assessment. Of them, 894 had at least one luteal-phase blood test taken on a known day after the peak mucus day.
Only 166 women (18.6%) reported no PMS symptoms. The most common was a physical symptom group (breast tenderness, bloating, weight gain, headache), reported by 626 of 894 women (70%).
Among these women, average progesterone was up to about 30% lower with symptoms than without. The difference was significant for most symptoms at 9 or more days after the peak mucus day.
Estradiol was generally lower in symptomatic women in this group, by up to about 15%. Only one difference was statistically significant: difficulty with concentration, 5 days after the peak mucus day.
Areas under the ROC curves for progesterone, estradiol and their ratio were very close to 0.5. Hormone levels did not discriminate women with symptoms from women without.

Interpretation

The study measured hormones and symptoms at one point in time, so the result is an association. The authors say the findings invite reconsideration of the view that low progesterone has no causal link to PMS. Women reported symptoms from recall. The symptom-free group was small (166 women). Every woman was seeking care for infertility or recurrent miscarriage, and the authors caution against extending the findings to the general population. Group averages differed, yet some symptomatic women had normal progesterone.

RRM Context

Each blood draw was timed from the peak mucus day the woman charted after learning a fertility awareness-based method. The authors state that steroid hormones vary across the cycle, so draw timing shapes what a result means. Serial ultrasound gives definitive timing of ovulation but is impractical for large groups. Peak mucus places ovulation within 2 days. Cycle charting made the luteal-phase comparison possible at this scale.

Our editorial summary of this paper, not the article's abstract.

Abstract

To determine the relationships between luteal-phase steroidal hormonal profile and PMS for a large number of women attending a dedicated fertility clinic. This was a retrospective cross-sectional study on women attending a hospital-based clinic for fertility concerns and/or recurrent miscarriage. All participants were assessed with a women's health questionnaire which also included evaluation of premenstrual symptoms. Day of ovulation was identified based on the peak mucus symptom assessed by the woman after instruction in a fertility awareness-based method (FABM). This enabled reliable timing of luteal-phase serum hormone levels to be taken and analysed. Between 2011 and 2021, 894 of the 2666 women undertaking the women's health assessment had at least one evaluable serum luteal hormone test. Serum progesterone levels were up to 10 nmol/L lower for symptomatic women compared with asymptomatic women. This difference was statistically significant (p < 0.05) for the majority of PMS symptoms at ≥ 9 days after the peak mucus symptom. A similar trend was observed for oestradiol but differences were generally not statistically significant. ROC curves demonstrated that steroid levels during the luteal phase were not discriminating in identifying the presence of PMS symptoms. Blood levels for progesterone were lower throughout the luteal phase in women with PMS, with the greatest effect seen late in the luteal phase.

Topics

Reproductive Endocrinology › Luteal Phase › Luteal Phase Deficiency · Menstrual Cycle › Premenstrual Disorders › Cyclical Symptom Patterns · Diagnostics › Hormone Testing › Serum Panels

Joseph V Turner, Lucas A McLindon, Damien V Turner, Yolaine Alefsen, René Ecochard

Joe Turner, Joey Turner, J Turner, L McLindon, D Turner, Y Alefsen, R Ecochard

PMID 37853154 37853154 DOI 10.1007/s43032-023-01375-w 10.1007/s43032-023-01375-w Turner et al. 2024, Turner 2024

Relationship Between Steroid Hormone Profile and Premenstrual Syndrome in Women Consulting for Infertility or Recurrent Miscarriage

Infertility clinic women with PMS had lower late-luteal progesterone

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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